People with narcolepsy may have a higher risk of other health conditions. When someone has more than one condition at the same time, it’s called a comorbidity.

Some health conditions also have symptoms that overlap with or are similar to narcolepsy. Because of this, narcolepsy may be misdiagnosed, or a comorbidity may be diagnosed while narcolepsy is missed. Either situation can delay getting the right treatment for narcolepsy.

Understanding common comorbidities and misdiagnoses of narcolepsy may help you recognize symptoms and talk with your doctor about treatment. Getting all your health conditions diagnosed and well managed can help improve your quality of life. However, getting the care you need for multiple conditions can be a challenge.

“I am, at the present moment, trying to find the right medication to treat my sleep apnea, restless legs syndrome, and narcolepsy,” one MyNarcolepsyTeam member shared. “It’s frustrating.” Another wrote, “​​I have multiple sleep problems that add to the effects of narcolepsy and make treatment complex.”

Read on to learn about other health conditions and how they may affect people with narcolepsy. If you’re concerned you might have more than one condition, consider talking with your doctor about getting checked.

1. Restless Legs Syndrome

Restless legs syndrome is a sleep disorder that causes uncomfortable sensations in your legs that improve when you move. The sensations often get worse when you try to relax. Restless legs syndrome can lead to poor sleep, which may cause symptoms like daytime sleepiness, trouble focusing, memory problems, or depression — many of which also occur with narcolepsy.

People with narcolepsy are almost four times more likely to have restless legs syndrome than people without narcolepsy.

One sleep medicine study found that 14.7 percent of people with narcolepsy type 1 (which includes cataplexy, or sudden muscle weakness) had restless legs syndrome compared with 3 percent of those without narcolepsy​.

Another study published in Sleep Advances found that people with narcolepsy were nearly four times more likely to have restless legs syndrome than people without narcolepsy. This study also identified restless legs syndrome as the most common comorbidity among people with narcolepsy.

“I haven’t been sleeping well at night,” one MyNarcolepsyTeam member said. “My restless legs are going nuts.” Another member posted: “I’m so sleep deprived — can’t sleep, as my legs hurt. I’ve had restless legs for decades.”

If you feel unusual sensations in your legs — such as itching, aching, burning, tugging — or have the urge to move them while trying to sleep, talk with your doctor. Treating restless legs syndrome may help improve your sleep and reduce some narcolepsy symptoms, such as excessive daytime sleepiness.

2. Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep disorder that causes pauses in breathing intermittently during sleep. Like narcolepsy, OSA can lead to excessive daytime sleepiness, trouble with memory and focus, and mood changes like depression.

OSA is a common narcolepsy comorbidity. One study found that people with narcolepsy were about 1.7 to nearly four times more likely to have OSA compared with the general population.

Several MyNarcolepsyTeam members who also have sleep apnea described how difficult it was to receive a correct diagnosis and proper care. “My doctor clearly told me when I was diagnosed with sleep apnea that he felt I had narcolepsy too!” one member shared. “Why didn’t he say this to me 20 years ago when I was diagnosed with sleep apnea?”

Another member wrote, “I was initially diagnosed with narcolepsy, but my sleep apnea nurse practitioner rarely mentions it. I ask her if I have narcolepsy, and she doesn’t answer the question. So how can you tell which is which?”

If you’re being treated for obstructive sleep apnea but still feel extremely tired during the day, talk with your doctor. You may need further testing to check for other sleep disorders, such as narcolepsy.

3. Periodic Limb Movements of Sleep

Periodic limb movements of sleep (PLMS) are repeated, brief twitching or jerking movements of the arms or legs that happen during sleep. These movements can disrupt rest and contribute to daytime sleepiness.

Many people with PLMS have restless legs syndrome, and narcolepsy has also been linked to PLMS. When these movements are frequent and cause sleep problems or daytime symptoms, a person may be diagnosed with periodic limb movement disorder (PLMD). If your sleep partner notices that you often twitch or kick while asleep, talk with your doctor about PLMS and whether further evaluation for PLMD might be helpful.

“It took years after I developed narcolepsy, PLMD, and REM sleep behavior disorder to get a diagnosis other than I was ‘depressed,’” shared a member who also lives with a condition that affects rapid eye movement (REM) sleep.

Read more about other nighttime symptoms of narcolepsy.

4. Depression

In one study of more than 1,600 people with narcolepsy, depression was the most frequently reported comorbidity. A large 2017 study of U.S. adults found that people with narcolepsy were 22.8 percent more likely to develop depressive disorders than those without narcolepsy. A third, more recent study estimated that about 32 percent of people with narcolepsy experience depression.

People with narcolepsy have a higher risk of depression and anxiety compared to the general population.

MyNarcolepsyTeam members have discussed how narcolepsy affects their mental health. “I also struggle from severe depression and anxiety,” wrote one. “I keep losing jobs from the narcolepsy, which ultimately makes my depression and anxiety worse!”

“I can understand this — narcolepsy is debilitating,” another member responded. “I miss out so much on life, canceling plans because I’d rather be asleep. The amount of depression that follows is unreal.”

Low energy, persistent fatigue, trouble concentrating, memory issues, social withdrawal, and weight gain can be symptoms of both depression and narcolepsy. Talk with a healthcare provider if you often experience these or other signs of depression, such as:

• Suicidal thoughts or behaviors
• Loss of interest in activities you once enjoyed
• Changes in eating habits
• Ongoing feelings of sadness

Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

5. Anxiety

Anxiety is also more common in people with narcolepsy. In the 2017 study mentioned above, adults with narcolepsy were 13.1 percent more likely to have anxiety disorders than those without narcolepsy. Some people with narcolepsy may experience panic attacks or social anxiety, especially if they worry about having a sleep attack or losing control of their body in public.

Nearly 200 members of MyNarcolepsyTeam report experiencing anxiety as a symptom of narcolepsy. Others have been diagnosed with anxiety disorders. One member listed their health conditions: “I’m dealing with narcolepsy, sleep apnea, asthma, and anxiety-panic disorder.”

Treating anxiety issues can also make life with narcolepsy more complex, as one member described: “I take something at night for my other two chronic disorders because it will make me too sleepy during the day. It’s for major depression disorder and anxiety disorder and anxiety attacks. It has helped a lot through the years, but if I have more trouble than usual with the narcolepsy, those two issues get worse.”

6. Bipolar Disorder

In the same study, participants with narcolepsy had a 6.2 percent higher chance of being diagnosed with bipolar disorder — swings of mood, energy, and focus that alternate between manic (high) and depressive (low).

“I also have type 2 bipolar disorder, so it’s difficult to determine which condition is causing any insomnia I experience,” wrote one member. Another shared how having both conditions can complicate treatment: “I have bipolar disorder and depression on top of my narcolepsy. Well, I have to stop my medication for my depression and bipolar.”

Getting the right diagnosis for all your health conditions is important. Some narcolepsy treatments can make other conditions worse. For example, in a case study of a 22-year-old with narcolepsy, treatment with modafinil (Provigil) and venlafaxine (Effexor) triggered more severe manic episodes linked to bipolar disorder.

7. Diabetes

Narcolepsy may raise the risk of metabolic conditions like diabetes. Because some symptoms overlap, it’s important to identify both conditions to get the right treatment. For example, uncontrolled diabetes can cause extreme fatigue when the body can’t use sugar properly for energy. Studies also suggest that disrupted sleep — common in narcolepsy — may lead to insulin resistance.

One theory is that hypocretin, the brain chemical that’s low in people with narcolepsy type 1, helps protect against diabetes. Without enough hypocretin, diabetes risk may increase.

Members of MyNarcolepsyTeam who also have diabetes have discussed the challenges of managing these comorbid conditions. “I’m tired a lot,” wrote one member. “Narcolepsy is harder to control when I’m having more medical issues. With gastroparesis and diabetes along with narcolepsy, I just want to sleep the day away.”

“Lots of falls and shaking lately — uncoordinated,” another member said. “Can’t tell whether it’s my sleep issue, my diabetes, or my depression — maybe all three.”

Talk with your doctor about diabetes screening if you have ongoing fatigue and other symptoms, like extreme thirst or blurry vision.

Join the Conversation

On MyNarcolepsyTeam, people share their experiences with narcolepsy, get advice, and find support from others who understand.

Are you living with other health conditions as well as narcolepsy? Let others know in the comments below.